Trigeminal paresthesia secondary to responsive neurostimulation (RNS) lead migration

Background: The responsive neurostimulation system (RNS) is used in patients with drug-resistant epilepsy who are not candidates for surgical resection of a seizure focus. As a relatively new therapy option, the adverse effects of long-term implantation are still being clarified. We present a series of two patients who presented with similar symptoms which were attributable to migration of the intracranially implanted subdural leads. Case Description: Two patients who had subdural RNS lead implantation presented with symptoms of paroxysmal unilateral facial pain which were thought to be related to the stimulation of the trigeminal nerve secondary to RNS lead migration. Adjustment of the stimulation parameters improved the symptoms in both patients. Conclusion: Chronically implanted subdural RNS leads can migrate over time stimulating nerves in the intracranial space. Strategies to avoid and overcome the complication are discussed.

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Case Report: 1-Year Follow-Up of Vagus Nerve Stimulation in a Dog With Drug-Resistant Epilepsy

Frontiers in Veterinary Science ◽

10.3389/fvets.2021.708407 ◽

2021 ◽

Vol 8 ◽

Author(s):

Junya Hirashima ◽

Miyoko Saito ◽

Hirotaka Igarashi ◽

Satoshi Takagi ◽

Daisuke Hasegawa

Keyword(s):

Adverse Effects ◽

Vagus Nerve ◽

Nerve Stimulation ◽

Vagus Nerve Stimulation ◽

Drug Resistant ◽

Stimulation Parameters ◽

Term Evaluation ◽

Drug Resistant Epilepsy

A vagus nerve stimulation (VNS) system was surgically implanted to treat drug-resistant epilepsy in a 5-year-old male Shetland Sheepdog. At regular visits during a 1-year follow-up, treatment efficacy and adverse effects were assessed, and programmable stimulation parameters were adjusted to optimize stimulation intensity while avoiding adverse effects. The frequency of generalized tonic–clonic seizures was reduced by 87% after the initiation of VNS. The owner reported that the dog regained his personality, and the quality of life of both the dog and owner improved. The only adverse effect of VNS was a cough that was controlled by adjusting stimulation parameters. There were no surgical complications or other issues with the VNS device. This is the first long-term evaluation of VNS therapy in a dog, and the results obtained suggest that gradual adjustments of VNS parameters facilitate optimum VNS dosing.

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Long-term effectiveness and adverse effects of ketogenic diet therapy in infants with drug-resistant epilepsy treated at a single center in Argentina

Epilepsy Research ◽

10.1016/j.eplepsyres.2021.106793 ◽

2021 ◽

pp. 106793

Author(s):

Marisa Armeno ◽

Antonella Verini ◽

Eugenia Caballero ◽

Araceli Cresta ◽

Gabriela Reyes Valenzuela ◽

...

Keyword(s):

Adverse Effects ◽

Ketogenic Diet ◽

Diet Therapy ◽

Drug Resistant ◽

Single Center ◽

Drug Resistant Epilepsy

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Long-term use of the ketogenic diet in drug resistant epilepsy syndromes during childhood: Differences between responders and non-responders in seizure types, EEG, and outcome

Neuropediatrics ◽

10.1055/s-0029-1215729 ◽

2008 ◽

Vol 39 (05) ◽

Author(s):

A Dressler ◽

E Reithofer ◽

B Stöcklin ◽

F Benninger ◽

M Freilinger ◽

...

Keyword(s):

Ketogenic Diet ◽

Drug Resistant ◽

Drug Resistant Epilepsy

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Long‐term outcomes of children with drug‐resistant epilepsy across multiple cognitive domains

Developmental Medicine & Child Neurology ◽

10.1111/dmcn.14815 ◽

2021 ◽

Author(s):

Klajdi Puka ◽

Mary Lou Smith

Keyword(s):

Drug Resistant ◽

Long Term Outcomes ◽

Cognitive Domains ◽

Drug Resistant Epilepsy

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Vagus nerve stimulation for drug-resistant epilepsy

Practical Neurology ◽

10.1136/practneurol-2019-002210 ◽

2019 ◽

Vol 20 (3) ◽

pp. 189-198 ◽

Cited By ~ 1

Author(s):

Laura Pérez-Carbonell ◽

Howard Faulkner ◽

Sean Higgins ◽

Michalis Koutroumanidis ◽

Guy Leschziner

Keyword(s):

Vagus Nerve ◽

Seizure Frequency ◽

Nerve Stimulation ◽

Vagus Nerve Stimulation ◽

Therapeutic Option ◽

Drug Resistant ◽

Drug Resistant Epilepsy ◽

Randomised Controlled

Vagus nerve stimulation (VNS) is a neuromodulatory therapeutic option for drug-resistant epilepsy. In randomised controlled trials, VNS implantation has resulted in over 50% reduction in seizure frequency in 26%–40% of patients within 1 year. Long-term uncontrolled studies suggest better responses to VNS over time; however, the assessment of other potential predictive factors has led to contradictory results. Although initially designed for managing focal seizures, its use has been extended to other forms of drug-resistant epilepsy. In this review, we discuss the evidence supporting the use of VNS, its impact on seizure frequency and quality of life, and common adverse effects of this therapy. We also include practical guidance for the approach to and the management of patients with VNS in situ.

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Long-Term Effects of a Classic Ketogenic Diet on Ghrelin and Leptin Concentration: A 12-Month Prospective Study in a Cohort of Italian Children and Adults with GLUT1-Deficiency Syndrome and Drug Resistant Epilepsy

Nutrients ◽

10.3390/nu11081716 ◽

2019 ◽

Vol 11 (8) ◽

pp. 1716 ◽

Cited By ~ 2

Author(s):

Ramona De Amicis ◽

Alessandro Leone ◽

Chiara Lessa ◽

Andrea Foppiani ◽

Simone Ravella ◽

...

Keyword(s):

Body Composition ◽

Nutritional Status ◽

Body Fat ◽

Deficiency Syndrome ◽

Drug Resistant ◽

Z Score ◽

Glut1 Deficiency ◽

Glut1 Deficiency Syndrome ◽

Drug Resistant Epilepsy

The classical ketogenic diet (cKD) is an isocaloric, high fat, very low-carbohydrate diet that induces ketosis, strongly influencing leptin and ghrelin regulation. However, not enough is known about the impact of a long-term cKD. This study evaluated the effects of a 12-month cKD on ghrelin and leptin concentrations in children, adolescents and adults affected by the GLUT1-Deficiency Syndrome or drug resistant epilepsy (DRE). We also investigated the relationship between the nutritional status, body composition and ghrelin and leptin variations. We carried out a longitudinal study on 30 patients: Twenty-five children and adolescents (15 females, 8 ± 4 years), and five adults (two females, 34 ± 16 years). After 12-monoths cKD, there were no significant changes in ghrelin and leptin, or in the nutritional status, body fat, glucose and lipid profiles. However, a slight height z-score reduction (from −0.603 ± 1.178 to −0.953 ± 1.354, p ≤ 0.001) and a drop in fasting insulin occurred. We found no correlations between ghrelin changes and nutritional status and body composition, whereas leptin changes correlated positively with variations in the weight z-score and body fat (ρ = 0.4534, p = 0.0341; ρ = 0.5901, p = 0.0135; respectively). These results suggest that a long-term cKD does not change ghrelin and leptin concentrations independently of age and neurological condition.

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